Reddington Christian Church
Wednesday Night Student Release Form
Child's Name *
Your answer
Grade in School *
Your answer
Address *
Your answer
Is there a parent on our campus during Wednesday nights? *
Parent(s)/Guardian Name *
Your answer
Parent/Guardian Cell Phone Number *
Your answer
Relationship to the Child *
Your answer
Any siblings that also attend on Wednesdays? *
Name(s)/Grade(s) of other siblings who attend on Wednesdays.
Your answer
Any notes about your child(ren) that would help the volunteers and staff of RCC?
Your answer
AUTHORIZATION TO OBTAIN URGENT OR EMERGENCY MEDICAL CARE. As the parent(s) or Custodial adult(s) of the above mentioned child/youth, I/we give permission for Reddington Christian Church, its agents, staff, and volunteers to obtain urgent or emergency medical care for my/our child, and I/we authorize health care providers to render such care as may be necessary. It is understood that reasonable efforts will be made to contact me/us prior to obtaining such care, but I/we authorize such care whether I/we are contacted or not, and I/we agree to be financially responsible for such care.(By typing your name and date below, you are agreeing to the above consent) *
Your answer
PERMISSION TO PARTICIPATE; RELEASE, WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT. I/we give permission for the above mentioned child/youth to participate in the activities of Reddington Christian Church. In consideration of the opportunity of my/our child/youth to participate in the activities of Reddington Christian Church, I/we release Reddington Christian Church, its officers, agents, employees, staff, and volunteers from any and all liability of any kind whatsoever for any loss or injury to my/our child/youth arising from my/our child/youth's participation in the activities of Reddington Christian Church; and I/we agree to indemnify and hold forever harmless the Reddington Christian Church, its officers, agents, employees, staff, and volunteers from any and all liability of any kind whatsoever for loss or injury to my/our child/youth arising from activities on or off the premises of Reddington Christian Church or resulting from traveling to or from the activities of Reddington Christian Church. I/we understand and agree that this permission and agreement shall remain in effect until revoked in writing by me/us. (By typing your name and date below, you are agreeing to the above consent) *
Your answer
PHOTO PERMISSION: I/we understand that my child may be photographed while participating in the activities of the Reddington Christian Church. I/we (do) give permission for a recognizable image of my child to be posted on the Reddington Christian Church website, social media, bulletin boards or in RCC promotional material. I understand, regardless, that a non-recognizable image, such as a group picture, may be posted. (By typing your name and date below, you are agreeing to the above consent) *
Your answer
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